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The main problem with palliative treatment of extrahepatic cholestasis with an endoscopic biliary endoprosthesis is clogging. One of the factors thought to be of importance is the diameter of the stent. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. In this article we report on our preliminary clinical experience with an endoscopically placed expandable metal stent ("Wallstent") in 33 patients with extrahepatic bile duct stenoses. When fully expanded, the stent has a diameter of 30 F and a length of 6.7 cm. It was possible to successfully place a stent in every patient. Clinical improvement was achieved in all patients except one. Two patients underwent elective surgery, while one died of renal failure. Another died of septic shock after 5 weeks, but no autopsy was performed. In conclusion, our initial experience with this stent shows that at least in the short term biliary drainage was excellent, with no complications of pancreatitis or hemorrhage. Longer follow-up than our 4 weeks is necessary to establish the position of this stent in comparison with the conventional endoprosthesis in the management of obstructive jaundice.

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Huibregtse K, Cheng J , Rauws EAJ, Tytgat GNJ. Postoperative biliary strictures: The endoscopic approach. Scand J Gastroenterol 1989, 24(suppl 171), 5G56Postoperative biliary strictures usually present with jaundice and/or cholangitis. Surgical reconstruction of these mostly proximal strictures is often associated with high morbidity and mortality. In addition, restenosis after surgery is common. We attempted endoscopic therapy in 63 consecutive patients with benign biliary strictures, by the placement of one or multiple 10 French endoprostheses. The procedure was successful in 54 out of 63 (86%) patients. All 54 had rapid clearance of jaundice and/ or cholangitis. Follow-up study during a median period of 32.5 (range, 1-96) months after stent removal of 35 patients showed 4 recurrent strictures and 5 recurrent stones. There was low morbidity and mortality associated with the procedures. Although placement of an endoprosthesis in this group of patients is technically difficult, we believe it should be considered as the initial therapeutic modality. The stents should preferably be multiple and left in situ for 1 year to avoid restenosis.Scand J Gastroenterol Downloaded from informahealthcare.com by James Cook University on 03/17/15For personal use only.